Fundamentals of Nursing Q 232
A nurse in a provider’s office is assessing a client who reports losing control of urine whenever she coughs, laughs, or sneezes. The client relates a history of three vaginal births, but no serious accidents or illnesses. Which of the following interventions are appropriate for helping to control or eliminate the clients incontinence? Select all that apply.
A. Limit total daily fluid intake
B. Decrease or avoid caffeine
C. Increase the intake of calcium supplements
D. Avoid the intake of alcohol
E. Use Crede maneuver
Correct Answer: B and D
Caffeine and alcohol are bladder irritants and can worsen stress incontinence. Alcohol is a bladder irritant and can worsen stress incontinence. Quitting smoking, losing excess weight, or treating a chronic cough will lessen the risk of stress incontinence and improve the symptoms. Stress incontinence is different from urgency incontinence and overactive bladder (OAB). If the client has urgency incontinence or OAB, the bladder muscle contracts, causing a sudden urge to urinate before he can get to the bathroom. Stress incontinence is much more common in women than in men.
Option A: Because stress incontinence results from weak pelvic muscles and other structures, limiting fluid will not resolve the problem. The doctor may recommend how much and when one should consume fluids during the day and evening. However, don’t limit what the client drinks so much that he becomes dehydrated.
Option B: Lifestyle changes should be made such as reducing caffeine intake (including green tea), stopping smoking, and losing weight.
Option C: Calcium has no effect on stress incontinence. Bladder training involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course usually lasts for at least six weeks and can be combined with the Kegel exercises. Some individuals may find that timed toileting is helpful, particularly for people with a learning disability or cognitive impairment.
Option D: The doctor may also suggest that the client avoid caffeinated, carbonated, and alcoholic beverages, which may irritate and affect bladder function in some people. If he finds that using fluid schedules and avoiding certain beverages significantly improves leakage, the client will have to decide whether making these changes in the diet are worth it.
Option E: The Crede maneuver helps manage reflex incontinence, not stress incontinence. Pelvic floor muscle training is a technique that strengthens the pelvic floor muscles and is an effective treatment for stress incontinence, especially if the muscle has been damaged.